Brunetto Bruna, Saraiva Leonardo, Callegari-Jacques Sidia Maria, Ferri Hérica, Lizott Helena Bernieri, Valões Ricardo, Fernandes Sabrina Alves, Hoppe Lisia, Fornari Fernando
Post Graduate Program in Dentistry, University of Passo Fundo, Passo Fundo, Rio Grande do Sul, Brazil.
Department of Statistics, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
Int J Hepatol. 2025 May 5;2025:5842659. doi: 10.1155/ijh/5842659. eCollection 2025.
Dental diseases are common in patients with cirrhosis. In these patients, reduced mastication might interfere with protein intake and contribute to malnutrition. We addressed the relationship between reduced mastication and dynapenia in patients with cirrhosis. This cross-sectional study involved patients with cirrhosis treated in a Brazilian center. Trained dentists performed oral examinations and tested the patients for nutritional parameters such as handgrip strength (HGS) and gait speed test (GST). Reduced mastication was presumed when a patient had molar edentulism (≥ 3 teeth), bad dental occlusion, or ill-fitting denture. Associations between mastication status and malnutrition were evaluated using multivariate linear regression analysis for continuous measures and adjusted prevalence ratio (PR (95% confidence interval)) for binary measures. We included 149 patients with cirrhosis (60 ± 13 years old, 76% men, 64% Child A, 60% due to alcoholism only). Reduced mastication affected 107 patients (72%), low muscle strength (decreased HGS) occurred in 45 (30%), and decreased GST was observed in 58 (41%, among 143 patients able to walk). Thirty-one out of 143 (22%) presented decreased HGS and GST, characterizing dynapenia. Reduced mastication was associated either with decreased HGS [PR = 2.28 (1.08-4.81), = 0.030; reduced mastication decreases the HGS mean by 12.5 kg for men ( < 0.001) and 8.1 kg for women ( = 0.065)] or with decreased GST [PR 1.97 (1.09-3.55), = 0.024; reduced mastication increased the time of GST by 1.1 s on average ( = 0.005)], adjusting for age, alcoholic etiology, and Child-Pugh classification. Reduced mastication is associated with dynapenia markers in patients with cirrhosis. Further studies are needed to assess whether oral rehabilitation can change the curse of malnutrition in this population.
牙科疾病在肝硬化患者中很常见。在这些患者中，咀嚼功能下降可能会影响蛋白质摄入并导致营养不良。我们研究了肝硬化患者咀嚼功能下降与肌肉减少症之间的关系。这项横断面研究纳入了在巴西一家中心接受治疗的肝硬化患者。训练有素的牙医进行口腔检查，并对患者进行营养参数测试，如握力（HGS）和步态速度测试（GST）。当患者出现磨牙缺失（≥3颗牙齿）、牙齿咬合不良或假牙不合适时，推测咀嚼功能下降。咀嚼状态与营养不良之间的关联通过多变量线性回归分析评估连续测量指标，并通过调整患病率比（PR（95%置信区间））评估二元测量指标。我们纳入了149例肝硬化患者（年龄60±13岁，76%为男性，64%为Child A级，60%仅因酒精性病因）。咀嚼功能下降影响了107例患者（72%），45例（30%）出现肌肉力量低下（HGS降低），58例（41%，在143例能够行走的患者中）观察到GST降低。143例中有31例（22%）出现HGS和GST降低，表现为肌肉减少症。咀嚼功能下降与HGS降低相关[PR = 2.28（1.08 - 4.81），P = 0.030；咀嚼功能下降使男性HGS平均值降低12.5 kg（P < 0.001），女性降低8.1 kg（P = 0.065）]，或与GST降低相关[PR 1.97（1.09 - 3.55），P = 0.024；咀嚼功能下降使GST平均时间增加1.1 s（P = 0.005）]，对年龄、酒精性病因和Child - Pugh分级进行了校正。咀嚼功能下降与肝硬化患者的肌肉减少症标志物相关。需要进一步研究来评估口腔康复是否能改变该人群营养不良的病程。
